33项轻躁狂症状清单和心境障碍问卷在老年单双相抑郁鉴别中的应用价值比较  

Comparison of the application value of 33-item hypomania checklist and mood disorders questionnaire in the differential diagnosis of unipolar and bipolar depression in the elderly

作　　者：张新乔 王刚 张庆娥 张玲 冯媛 齐涵 ZHANG Xin-qiao;WANG Gang;ZHANG Qing-e;ZHANG Ling;FENG Yuan;QI Han(The National Clinaical Reserch Center for Mental Disorders&Beijing Key Laboratory of Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China)

机构地区：[1]首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室,100088

出　　处：《临床精神医学杂志》2023年第1期15-18,共4页Journal of Clinical Psychiatry

摘　　要：目的:比较33项轻躁狂症状清单(HCL-33)和心境障碍问卷(MDQ)在老年单相抑郁(MDD)和双相抑郁(BD)鉴别中的应用价值。方法:采取成组设计的方法,纳入符合美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)的MDD(108例)和BD(107例)诊断标准的患者。以DSM-IV的诊断为金标准,采用ROC曲线进行分析,确定HCL-33和MDQ区分MDD和BD,MDD和BD-I,MDD和BD-II以及BD-I和BD-II的最佳划界分,分别计算灵敏度和特异度。采用Medcalc软件对ROC曲线进行比较,分析这两种工具的诊断价值是否存在差异。结果:ROC曲线结果显示HCL-33区分MDD和BD的ROC曲线下面积(AUC)为0.909(95%CI:0.870~0.948,P<0.001),最佳划界分为14分,灵敏度为88.8%,特异度82.4%;MDQ区分MDD和BD的AUC为0.926(95%CI:0.883~0.957,P<0.001),最佳划界分为7分,灵敏度86.0%,特异度为88.9%。采用Medcalc软件对ROC曲线进行比较,结果显示HCL-33和MDQ在老年人群中区分MDD和BD、MDD和BD-I,MDD和BD-II以及BD-I和BD-II的诊断效能差异均无统计学意义(P>0.05)。结论:HCL-33和MDQ量表在老年抑郁人群中识别BD时均有较好的诊断效能,两者诊断效能相当,均可以作为老年抑郁人群中识别BD的筛查工具。Objective:To compare the application value of the 33-item Hypomania Checklist(HCL-33)and the Mood Disorders Questionnaire(MDQ)in the differentiation of unipolar depression(MDD)and bipolar depression(BD)in the elderly.Method:A group design method was adopted.Patients who met the diagnostic criteria of diagnostic and statistical manual of mental disorders-IV(DSM-IV)for MDD(n=108)and BD(n=107)were included.With DSM-IV diagnosis as the gold standard,ROC curve analysis was used to determine the optimal cut-off of HCL-33 and MDQ score distinguishing MDD and BD,MDD and BD-I,MDD and BD-II,and BD-I and BD-II respectively,sensitivity and specificity were calculated respectively.ROC curves were compared with Medcalc to determine whether the difference between the two tools was significant.Results:ROC curve results showed that the area under the ROC curve(AUC)of HCL-33 distinguishing MDD and BD was 0.909(95%CI:0.870-0.948,P<0.001),the optimal cut-off of HCL-33 total score was 14,with sensitivity of 88.8%,and specificity of 82.4%.MDQ distinguishes MDD and BD-I with an AUC of 0.926(95%CI:0.883-0.957,P<0.001),the best demarcation score was 7 points,the sensitivity was 86.0%,and the specificity was 88.9%.Medcalc was used to compare the diagnostic efficacy of HCL-33 and MDQ in distinguishing between MDD and BD,MDD and BD-I,MDD and BD-II,and BD-I and BD-II in the elderly and the results showed no significant difference(P>0.05).Conclusion:HCL-33 and MDQ both have good diagnostic efficiency in identifying BD in elderly depressed people,and have the same diagnostic efficiency,and both can be used as a screen for identifying BD in elderly depressed people.

关 键 词：老年人 双相障碍 33项轻躁狂症状清单 心境障碍问卷 诊断效能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]